Health Outcomes and Biomedical Informatics

Point-of-care Intervention to Address Financial Toxicity in Patients with Cancer

Faculty Mentor’s Name: Dr. Ramzi Salloum
Phone Number: (352) 294-4997
Project Category: Clinical
International Component or Travel: No

Research Project Description:
Treatment advances in cancer care have come with increases in treatment costs that have impacted cancer patients, leading to financial toxicity. Financial toxicity refers to the mental, physical, and emotional stress that is caused by the costs of cancer treatments, and has been shown to result in reduced quality of life, reduced treatment adherence, and poor survival outcomes. Notably, a clear divide exists between urban and rural populations with respect to the burden of financial toxicity due to cancer. The CDC reports that compared to urban survivors, rural cancer survivors were more likely to forgo medical care due to cost. Rural patients also face additional barriers, such as a lack of or limited nearby health delivery services, and transportation time and cost to access treatment facilities. Given these factors, rural cancer patients are at an increased risk of financial toxicity compared to urban patients. Despite these disparities, there is a paucity of research on interventions that address cancer-induced financial toxicity in rural populations. Identifying patients who experience financial toxicity and testing interventions to connect them with financial counseling services is a promising strategy. As most recent experiences have revealed, telehealth has become a critical link to support cancer patients in the context of situations that may prevent them from in-person visits such as stay-at-home orders experienced nationwide in response to the COVID-19 pandemic. Telehealth platforms may be especially effective for rural cancer patients who experience additional challenges in accessing healthcare services. Our specific aims are to: (1) Assess the feasibility, acceptability, and usability of a group and individual telehealth platform format to deliver financial counseling to cancer patients with financial toxicity; (2) Evaluate the preliminary efficacy of financial counseling in reducing financial toxicity and improving cancer treatment adherence in a randomized control trial; and (3) Explore the feasibility of using the EHR to automatically identify patients with financial toxicity.
Medical students will work on all aspects of the study by assisting in facilitating implementation in clinical settings, assisting with focus groups and training activities, contributing to qualitative and quantitative analysis of study results, and dissemination of study findings at scientific meetings and in peer-reviewed publications.

Hong YR, Salloum RG, Yadav S, Smith G, Mainous AG. Patient-provider discussion about cancer treatment costs and out-of-pocket spending: Implications for shared decision-making in cancer care. Value in Health, 2020.

Tobacco Prevention with Adolescents: A Randomized Controlled Trial

Faculty Mentor’s Name: Dr. Georges Khalil
Phone Number: (513) 885-5570
Project Category: Translational
International Component or Travel: No

Research Project Description:
Substance use behaviors such as tobacco use are typically initiated during adolescence, leading to early nicotine dependence, signs of pulmonary and cardiovascular diseases, and carcinogenic processes at young age. Negative influence from peers is a well-known predictor of adolescent tobacco use. However, what is not known is how to design and implement an intervention that promotes positive social influence for adolescents (i.e., connection with and support from others who do not intent to smoke). Social game-play has been identified as a strategy that can promote positive social interaction (1-3). During this summer term, Funded by National Institute on Drug Abuse (R00DA044277), Dr. Khalil will be conducting an IRB-approved pilot randomized controlled trial to test the feasibility and short-term effectiveness of a game-based tobacco prevention and cessation program for adolescents. During this project, the Summer Intern will have the opportunity to gain skills in the study of game-based social interventions for tobacco prevention. Particularly, the Summer Intern will engage in data collection in the community, implement and deliver the game-based intervention, and contribute to the analysis of qualitative and quantitative data (qualitative interviews, statistical data, and social network data). The study may also involve the analysis of salivary cotinine samples from adolescents.

1. Khalil GE. When losing means winning: the impact of conflict in a digital game on young adults’
intentions to get protected from cancer. Games for Health: Research, Development, and Clinical
Applications. 2012;1(4):279-286. PMID: 26191631
2. Khalil GE, Beale IL, Chen M, Prokhorov AV. A video game promoting cancer risk perception and
information seeking behavior among young-adult college students: a randomized controlled trial.
Journal of Medical Internet Research Serious Games. 2016;4(2):e13. PMCID: PMC4981692
3. Khalil GE, Wang H, Calabro KS, Mitra N, Shegog R, Prokhorov AV. From the Experience of Interactivity and Entertainment to Lower Intention to Smoke: A Randomized Controlled Trial and Path Analysis of a Web-Based Smoking Prevention Program for Adolescents. Journal of medical Internet research. 2017;19(2):e44. PMID: 28209560